Journal of Postgraduate Medicine, Education and Research

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VOLUME 57 , ISSUE 3 ( July-September, 2023 ) > List of Articles


Refractory Hyponatremia as an Initial Presentation of Panhypopituitarism with Partial Empty Sella

Deepak Thakran

Keywords : Case report, Empty sella, Hyponatremia, Hypopituitarism

Citation Information : Thakran D. Refractory Hyponatremia as an Initial Presentation of Panhypopituitarism with Partial Empty Sella. J Postgrad Med Edu Res 2023; 57 (3):137-139.

DOI: 10.5005/jp-journals-10028-1628

License: CC BY-NC 4.0

Published Online: 26-07-2023

Copyright Statement:  Copyright © 2023; The Author(s).


Introduction: Hyponatremia of varying severity is a fairly common disorder of water homeostasis encountered in the practice of internal medicine and has a variety of etiologies. Here we present a case of refractory hyponatremia secondary to an uncommon endocrine disorder. Case description: Our patient, a 55-year-old woman with a known case of hypothyroidism for 5 years, presented with complaints of moderate, symptomatic, and persistent hyponatremia. An evaluation revealed chronic euvolemic hyponatremia refractory to 3% saline. Further workup to rule out the syndrome of inappropriate antidiuretic hormone (SIADH) revealed panhypopituitarism with partial empty sella (PES). Discussion: Though usually not associated with any hormonal deficiency, rarely PES is associated with a deficiency of one or more pituitary hormones. Equally rare is the syndrome of euvolemic hyponatremia secondary to empty sella syndrome with hypopituitarism. Panhypopituitarism can have life-threatening consequences if left undiagnosed and untreated. Conclusion: In any case of euvolemic hyponatremia, it is important to work up for hypopituitarism as a rare cause before ruling in SIADH.

  1. Okuno S, Inaba M, Nishizawa Y, et al. A case of hyponatremia in panhypopituitarism caused by the primary empty sella syndrome. Endocrinol Jpn 1987;34(2):299–307. DOI: 10.1507/endocrj1954.34.299
  2. Busch W. [Morphology of sella turcica and its relation to the pituitary gland]. Virchows Arch Pathol Anat Physiol Klin Med 1951;320(5):437–458. DOI: 10.1007/BF00957474
  3. Aijazi E, Shama F, Mukhtar S. Primary empty sella syndrome presenting with severe hyponatremia and minimal salt wasting. J Ayub Med Coll 2016;28(3):605–608. PMID: 28712246.
  4. Ekhzaimy AA, Mujammami M, Tharkar S, et al. Clinical presentation, evaluation and case management of primary empty sella syndrome: a retrospective analysis of 10-year single-center patient data. BMC Endocr Disord 2020;20(1):142. DOI: 10.1186/s12902-020-00621-5
  5. Empty sella syndrome. National Organisation for rare disorders. Available at:
  6. Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol 2014;170(3):G1–G47. DOI: 10.1530/EJE-13-1020
  7. Chanson P. Severe hyponatremia as a frequent revealing sign of hypopituitarism after 60 years of age. Eur J Endocrinol 2003;149(3):177–178. DOI: 10.1530/eje.0.1490177
  8. Farhan A, Tanveer T, Mumtaz U, et al. Hyponatremia-finding the cause. Endocrinol Metab Syndr 2016;5(5). DOI: 10.4172/2161-1017.1000253.
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